Leads, develops and directs the strategic clinical operations of VBH-PA to ensure the effective design, implementation and cost-effective delivery of behavioral health/substance abuse/rehabilitation services for HealthChoices members. Builds strategic alliances with the clients. Represents VBH-PA at county board, operations, and/or monitoring meetings. Local travel required within the state, occasionally overnight.
- Participate with and work collaboratively as part of the VBH-PA senior management team.
- Provide direct supervision to the clinical director and direct the operations and strategic initiatives of the clinical department
- Develop, implement and monitor all corrective action plans of the clinical department to ensure compliance with HealthChoices, Department of Public Welfare and County standards
- Provide innovation and efficiencies to the overall Care Management program of VBH-PA
- Monitor and support the annual and supplemental training needs of the clinical department including training on evidence-based practices (EBP), Resiliency and Recovery (R&R) and county based treatment alternatives.
- Monitor and support the clinical supervision program of the clinical department
- Monitor and support the clinical audits including documentation audits, phone audits and provide continuous feedback to clinical team regarding findings.
- Establish and monitor clinical department operations designing interventions when standards and benchmarks are not met.
- Establish, monitor and control clinical department productivity by developing benchmarks, regular reports and designing interventions when benchmarks are not met.
- Oversee all clinical and medical department workflows and ensure compliance with HealthChoices and ValueOptions Policies and Procedures.
- Participate in the Quality of Care oversight Committee with the Medical and Quality director and ensure clinical department compliance with HealthChoices and ValueOptions Policies and Procedures
- Work collaboratively with Provider Relations and Quality management to establish, coordinate and conduct provider trainings and interventions to maximize provider adherence to EBP’s, resiliency and recovery, and improve access to the right services at the right time.
- Conduct annual policy and procedure reviews of ValueOptions, HealthChoices, and local clinical policies and make modifications when need and provide annual trainings for the clinical team to ensure compliance with all policies and procedures.
- Participate in contract specific operations and/or board of director meetings.
- Participate as a voting member of the Compliance Committee.
- Work collaboratively with matrix lead, medical director and service center lead.
- Promote and ensure compliance with the Mission, Vision and Values of ValueOptions in all clinical activites.
Education: Minimum Masters Degree in a behavioral health discipline with an independent practice license (LCSW, LPC, LMFT, APN) required; PhD or PsyD in psychology from an accredited school preferred.
Licensures: Current PA state license for independent practice
Relevant Work Experience : At least 7 years’ experience in progressively more responsible leadership positions in clinical/ utilization/network management in the behavioral health managed care field (public or private sector) or human services sector. A sound knowledge of managed care clinical/network design programs, MEDICAID, managed care financing, service access and delivery models, and health plan utilization management/service delivery issues is essential. Must have strong TQM/CQI orientation and competence in clinical care management.
Value Options - 19 months ago
FHC Health Systems provides stability through its behavioral health care services, which are offered to millions of people through its...